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    How e-prescribing can prevent errors

    The ability offers vital communication link for physicians, pharmacists, and patients


    Electronic prescribing (e-prescribing) increases patient safety, experts say. This tool not only eliminates interpretation errors from handwritten prescriptions, it creates a communications bridge between the physician, pharmacist, and patient.

    And its use has been steadily increasing since its adoption, according to a National Progress Report issued annually by Surescripts. In 2011, it was estimated that close to 60% of physicians in office-based practices were e-prescribing. According to the 2012 Medical Economics Continuing Study, that number has jumped to 67%.

    The Health Information Technology for Economic and Clinical Health Act, which was enacted in 2009 as part of the American Recovery and Reinvestment Act, installed e-prescribing as a core menu item for attesting to meaningful use. In addition, the Medicare Electronic Prescribing Incentive program requires eligible professionals (including physicians) to report e-prescribing activities at least 10 times each year for 2011 and 2012 or find their payments reduced in 2013-2014. So as you can see, the government is serious about e-prescribing as well.

    So, if you're not already e-prescribing, you probably will be soon.


    Erika Bliss, MD, president and chief executive officer of Qliance, a Seattle, Washington-based network of "direct practice" clinics (aka, direct primary care medical homes) that don't accept insurance and that currently charge patients less than $100 per month for unlimited primary care, says she "can't imagine not having it at this point."

    Qliance has been "electronic" from the beginning. The network never has used paper charts. All five clinics are connected through a Web-based electronic health record (EHR) system. And according to Bliss, e-prescribing was extremely important from the start.

    "It was a 'must-have,' " she says, "so we chose an EHR system that had it built in."

    Bliss advises primary care physicians who aren't already e-prescribing to begin immediately. At minimum, she says, if you're not ready to implement a full EHR with built-in e-prescribing capabilities, at least install one of the free stand-alone e-prescribing systems.

    —Erika Bliss, MD
    "From a patient safety perspective, I don't think there's any excuse not to e-prescribe, especially when there are free products out there," Bliss says. "We're well past the point now where you can justify written prescriptions for so many reasons. First of all, they're totally unsafe, because most people don't write that clearly. They're also very easy to misinterpret."

    To make matters worse, Bliss says, when written prescriptions are faxed to pharmacies, a pharmacy technician must manually enter them into the pharmacy's electronic systems, inviting even more errors.

    "Anytime you have any sort of transcription happening in a chain of information transfer, you're at a very high risk of making mistakes, and, unfortunately, they happen all the time," she says.

    The most common errors, Bliss adds, involve incorrect refill information being input into the pharmacy systems, even though the prescription itself is properly transcribed. That mistake can seem pretty harmless, she says, but it wastes the time of practices, patients, and the pharmacy.


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